Thank you for your question.
You submitted several photos and you state that you’ve had otoplasty performed 18 months
prior.
And that with the photos, you described that there appears to be this area that you’re
referring to as a keloid and you are asking who is best to see, a plastic surgeon or a
dermatologist?
Well, I can certainly share with you my perspective on this question.
A little bit of background, I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial
plastic and reconstructive surgeon.
I’ve been in practice in Manhattan and Long Island for over 20 years.
Otoplasty is something we offer in our practice and I have a lot of experience performing
this procedure so I think I can share with you what my questions would be even though
there is no physical examination.
So to begin with, when we talk about doing otoplasty, you have to understand that most
likely what you had was an incision that was done in the crease behind the ears, essentially,
in the same area where this elevated lesion is present.
Now from that crease, you can access the middle part of the ear as well as the upper part
of the ear, essentially, the conchal bowl as well as the antihelical fold.
The question that I have when I look at this area is that if you had sutures that were
placed to bring the conchal bowl in.
For example, when someone has very prominent or hypertrophic conchal bowl, then you can
resect or remove some of that cartilage and then you suture the cartilage to the mastoid
fascia or to the base where the bone is.
Now what comes to mind when I see something like this, it’s not so much that you have
a thickened scar but I wonder is are you getting a reaction to the suture material?
Is it possible that you may have had some exposure or you may have started developing
an infection?
A suture could have stuck out, a suture can be irritating that area but I would, before
coming to the conclusion that this is a keloid, I would recommend that you actually see the
doctor who actually performed the surgery.
The doctor who performed your surgery has a clear understanding of exactly what was
done and would be able to be more likely to be able to make the proper diagnosis and do
the proper evaluation.
If they suspect or they have experienced where something like this happened in other patients,
then that puts them in a different much more better position than someone new seeing this
area.
I think that if you aren’t able to reach that doctor, then someone who is a surgeon
who performs otoplasty is the next best choice.
So I would say a cosmetic surgeon or plastic surgeon would be appropriate because these
doctors do these procedures and would actually know their way around.
With due respect to dermatologists, they don’t perform routinely, dermatologists don’t
perform this type of surgery and they may not feel as comfortable doing something such
as opening things up and exploring to figure out is there suture material, is there some
kind of a foreign body issue there, does it need to be cleaned out.
It’s not just about injecting steroids or doing something assuming that it is a scar.
So you need a proper diagnosis and again I would recommend you to see the original surgeon
to be able to make that evaluation.
And if that’s not possible, find a cosmetic or plastic surgeon who can help you deal with
this but I would not wait.
I would say, try to bring it to someone’s attention as soon as you can.
So I hope that was helpful, I wish you the best of luck and thank you for your question.